Over the last several years, HCC has risen in incidence in the United States, becoming one of the top causes of cancer death, Mody says. However, there is finally an array of treatment options for these patients. For over a decade, sorafenib (Nexavar) was the only FDA-approved frontline agent, but 2018 brought an explosion of positive trials and regulatory approvals. Mody says researchers need to now use this success as a foundation for the next challenge, which is optimally sequencing these agents.

Another TKI, lenvatinib (Lenvima), was found to be noninferior to sorafenib, which led to its FDA approval for the frontline treatment of patients with advanced disease. Longer follow-up data, however, has suggested a slight advantage in response rate and progression-free survival for lenvatinib. A potentially effective way of sequencing these agents is to look at the etiology of a patient’s underlying liver disease, Mody says, and to assess their risk factors.

In the second-line setting, there is another long list of therapies that are under investigation. Pembrolizumab (Keytruda), nivolumab (Opdivo), ramucirumab (Cyramza), and cabozantinib (Cabometyx) are among the agents that have shown efficacy for patients who progress on a frontline TKI.

Over the last several years, HCC has risen in incidence in the United States, becoming one of the top causes of cancer death, Mody says. However, there is finally an array of treatment options for these patients. For over a decade, sorafenib (Nexavar) was the only FDA-approved frontline agent, but 2018 brought an explosion of positive trials and regulatory approvals. Mody says researchers need to now use this success as a foundation for the next challenge, which is optimally sequencing these agents.

Another TKI, lenvatinib (Lenvima), was found to be noninferior to sorafenib, which led to its FDA approval for the frontline treatment of patients with advanced disease. Longer follow-up data, however, has suggested a slight advantage in response rate and progression-free survival for lenvatinib. A potentially effective way of sequencing these agents is to look at the etiology of a patient’s underlying liver disease, Mody says, and to assess their risk factors.

In the second-line setting, there is another long list of therapies that are under investigation. Pembrolizumab (Keytruda), nivolumab (Opdivo), ramucirumab (Cyramza), and cabozantinib (Cabometyx) are among the agents that have shown efficacy for patients who progress on a frontline TKI.